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In Reply: Goodman et al¹ explain that outcomes such as life expectancy and infant mortality are a function of many factors besides medical care. Important variables include diet, social status, social stability, wealth, and risk-taking behavior—as well as genetic endowment. Additionally, they argue that the health of US residents is not poorer than that of people who live under single-payer health systems. Their argument is buttressed by extensive references to official statistics and the medical literature, which cannot be cited in a brief book review or letter.

Median life expectancy at birth for members of the European Union is 81.2 years for women and 75.1 years for men,² compared with 80.1 years and 74.7 years, respectively, for US non-Hispanic whites.³ Median life expectancy at age 65 years, perhaps a better reflection of medical care, is 19.2 years for women and 15.7 years for men in the European Union, compared . . . [Full Text of this Article]

Jane M. Orient, MD
jorient@mindspring.com
Association of American Physicians and Surgeons
Tucson, Ariz

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